When the internet drops mid-OPD: a plan for Indian clinics What stops, what to keep ready, and how to catch up once it is back.

Keep the OPD running on three things set up in advance: a second internet connection from a different mobile carrier, battery backup for the router, the front-desk computer and the printer, and a paper token register and parchi pad the desk can switch to in a minute. When the connection returns, enter the paper visits the same day, in token order, before you close the day. Software with a real offline mode shrinks how much goes on paper, but the plan should never depend on a single connection or a single power socket.

What actually stops when the connection drops?

Less than the panic at the desk suggests, and not always the things people expect. Go through what your clinic uses and write down which column each one falls in.

Is it the internet, or the power?

At many OPD desks the "internet is down" moment is a power cut at the router, which sits on a socket the inverter does not cover. Spend two minutes finding out which one it is before switching to paper.

1. Look at the router. No lights means no power: move it to a socket on the UPS or inverter.
2. Lights on but no internet: open any website on a phone using mobile data. If that works, the problem is your broadband line, not the area.
3. Restart the router once. Not three times.
4. Call the broadband provider, give the account number from the card taped to the router, and write the complaint number and time in the register.
5. Switch the desk computer to the backup hotspot. If that does not work within your agreed time limit, switch to paper.

The backup kit to set up before you need it

None of this needs special equipment, but all of it has to exist before the morning it is needed. Check it once a month, on a quiet afternoon.

• A second connection on a different carrier. A prepaid SIM from a different company than your broadband or main mobile network, in a spare phone or a portable hotspot device kept charged at the desk. Keep a data pack active on it; a SIM with no recharge is no backup.
• Battery backup for the router, the front-desk computer and the printer. If the inverter covers only the fans and lights, ask your electrician to add these sockets, and to check the backup can carry the printer, since printers differ a lot in how much power they draw.
• A paper token register with ruled columns: token number, time, patient name, phone number, new or old patient, fee, payment mode, payment reference, and a last column headed "Entered".
• A parchi pad and a money receipt book pre-printed with the clinic name, the doctor's name and qualifications, and the registration number. Regulation 1.4.1 of the 2002 conduct regulations asks every doctor to display their registration number "in all his prescriptions, certificates, money receipts given to his patients", so a blank pad is not good enough. Use pads with a carbon copy, so the clinic keeps one.
• A card at the desk with the broadband account number, the complaint line, the hotspot's Wi-Fi password, and the name of the person who decides when the desk switches to paper.
• One agreed time limit. For example: if the hotspot does not get the desk working in ten minutes, the desk goes to paper and stays on paper until the queue is under control.

Running the OPD on paper for an hour

The aim is that the patients on the benches notice nothing except that the token slips are handwritten.

1. Write the time of the switch in the register, and the last token number the software issued. Continue from the next number so no two patients share a token.
2. For each patient, fill one register line: token, time, name, phone number, new or old, fee, payment mode.
3. The doctor writes on the pre-printed parchi pad. The carbon copy stays at the clinic with the register.
4. Issue receipts from the pre-printed receipt book, and write the receipt number in the register.
5. Keep the register at the desk, face down or in a drawer between patients. It now holds the same names and phone numbers your software does.
6. When the connection returns, do not stop the queue to catch up. Switch new arrivals back to the software and enter the paper lines in the gap after the rush.

How do you confirm a UPI payment when the desk is offline?

The patient's UPI payment travels over the patient's phone and mobile data, so it usually goes through even when the clinic's internet is down. What the desk loses is the view of it: a payment dashboard or desk app on Wi-Fi cannot show the credit. Plan for a second way to see it.

• Keep the phone that receives alerts for the clinic's bank account on mobile data, not on the clinic Wi-Fi, so the credit SMS or app notification still arrives.
• If your bank or payment provider gave you a soundbox, ask whether it runs on its own SIM or on your Wi-Fi. Only the first kind keeps announcing during an outage.
• When neither is available, look at the patient's screen, and write the amount and the last few digits of the transaction reference in the register with the word "check". Match it at the day's close.

Sometimes the patient's account is debited and nothing reaches the clinic. The Reserve Bank of India's circular of 20 Sep 2019 on failed transactions (DPSS.CO.PD No.629/02.01.014/2019-20) sets outer limits for this. For UPI, where the patient's account is debited but the beneficiary account is not credited, the money is to be auto-reversed "latest on T + 1 day". Where the account is debited but "transaction confirmation not received at merchant location", the limit is "Auto-reversal within T + 5 days". In both cases the bank pays ₹100 per day of delay beyond the limit, credited to the customer "suo moto, without waiting for a complaint". T is the day of the transaction.

In practice: the money either reaches the clinic's account or goes back to the patient on its own. Note the reference and amount, mark it pending in the register, and agree with the patient how the fee will be settled if it is reversed. Do not quietly take a second payment. Our guide to closing the day covers matching these at the end of the day.

Entering the paper visits once you are back online

Do it the same day, before the day is closed. A register left for tomorrow becomes a register left for next week, and the day's collection will not match.

1. Check the software has synced or reconnected before you start, so you are not entering visits it already has.
2. Enter the register lines in token order. One person reads, one person types.
3. Register any new patients first, then their visits. Check the phone number against existing patients before creating anyone, so a returning patient does not become a duplicate.
4. Record each fee with the payment mode the patient actually used. If your software lets you add a note, write "paper, outage" and the real time of the visit.
5. Tick the "Entered" column on each line as it goes in. At the end, every line has a tick or a reason.
6. File the register page and the parchi carbon copies with the day's records. They are part of the record; see how long to keep medical records.

The paper register is patient data too. Section 3 of the Digital Personal Data Protection Act, 2023 applies the Act to personal data collected "in non-digital form and digitised subsequently", so the moment those lines are typed in, they are digital personal data like the rest. Section 8(5) asks a clinic to take "reasonable security safeguards to prevent personal data breach". Keep the register locked away after hours, and do not send photos of its pages to a personal WhatsApp group to "enter later from home".

What to ask any clinic software vendor about offline mode

"Works offline" can mean anything from a full day's OPD to a screen that shows the last page you opened. Ask these questions, and ask for a demo with the Wi-Fi switched off.